Coding Denial

When a claim is denied as "Dx code invalid," what is likely the issue?

• The patient's age is incorrect.

       

• The procedure was not necessary.

• The diagnosis code provided does not match the patient's condition.

• The claim was not submitted by the provider.

Which denial reason suggests a mismatch between the submitted procedure code and the actual service rendered?

• CPT code invalid

      

• DX code invalid

•   CPT inconsistent with Patient’s age

• CPT inconsistent with Provider specialty

When would you use modifier -25?

• To indicate a separately identifiable evaluation and management service

• To indicate a repeat procedure on the same day

• To indicate a bilateral procedure

• To indicate a surgical service provided by a resident.

In which case might the patient's demographic information be relevant to the claim denial?

• CPT code invaid

• Dx code invalid

• CPT inconsistent with Patient’s age

• CPT inconsistent with Provider’s gender

Which department’s responsibility is to fix the issue, if claim is denied for “Procedure code inconsistent with patient age”?

• AR department

• Coding department

• Billing department

• Patient is responsible to pay

Claim is billed to Aetna and its denied as The diagnosis is inconsistent with the procedure, as per Coding team its a correct diagnosis code combination, claim was sent for reprocessing, reprocess also got denied for same reason, what is the next step?

• Bill patient

• Appeal with Medical records

• Adjust the claim

• None of the above.

Claim was billed to Medicare and as per Insurance, the correct POS is 22 but as per our medical records and claim form the POS is 21, can we submit the corrected claim to Medicare?

• Yes

• No

• None of above

If the claim is denied for DX codes is invalid and if CCTFL is crossed, we can still submit the corrected claim to Insurance?

• Appeal

• Adjust

• Call and reprocess the claim

• None of the above

If in previous DOS the claim was paid by Insurance same CPT combination was paid. and the DOS that we are working for is denied, what will be the next step

• Reprocess the claim, as the previous DOS is paid

• Adjust

• Billing departmet

• None of the above.

What could be inferred if a claim is denied for "CPT inconsistent with Patient gender"?

• The patient refused the procedure.

• The procedure is not typically performed on that gender.

• The provider lacks experience with that gender.

    

• The procedure is experimental.